There are many ways to pressure an institution into steering clear of providing abortion. In Toledo, Ohio, the last remaining abortion clinic may be forced to close next week after area hospitals refused to provide transfer agreements, citing a desire to remain “neutral” in the abortion debate. Earlier this month, the sole abortion doctor in Green Bay, Wis., agreed to stop providing the procedure after a local private hospital acquired his clinic. This comes as laws tightening regulations on abortion providers threaten to close clinics in at least five states, part of a Republican-led push that both pro-life and pro-choice activists say is designed to chip away access to abortion rights.

Now a group of medical professors is responding to the crackdown by urging hospitals to fill the void and reverse a decades-long trend that has isolated abortion providers from the mainstream medical community. The effort comes alongside a change in the kinds of professionals who work in women’s health. Ob-gyns are increasingly young and female doctors who, medical professors say, hold different attitudes toward abortion than their older male colleagues.

In a statement set to be published in the September issue of the American Journal of Obstetrics and Gynecology, 100 ob-gyns condemn new state restrictions on abortion as a “political regression.” The article, obtained by TIME, criticizes hospitals for relinquishing abortion to stand-alone clinics that are easily targeted by abortion activists, and calls on the medical community to integrate the procedure into women’s-health services and medical training.

“In our view, hospitals have disregarded the responsibility that our academic predecessors expected them to assume,” the professors write. “The savings in lives and money from legalization were soon forgotten and many hospitals now claim they cannot afford to provide abortions even if they wanted to …”

It’s a rare call to arms for the medical community, which tends to lay low when it comes to abortion. A 2011 study from the American College of Obstetricians and Gynecologists found that while 97% of ob-gyn doctors in the U.S. have met with a patient who wants an abortion, just 14% actually perform the procedure.

Hospitals provide just 4% of abortions in the U.S., according to the Guttmacher Institute, a nonprofit sexual-health-research organization, and many facilities limit the procedure to rare cases, like fetal abnormalities or when the life of the woman is at risk. The majority of hospitals perform fewer than 30 abortions per year. Others refuse to provide the procedure at all.

In their statement, the ob-gyn professors point out that the medical community has not always sought to marginalize abortion. In fact, an open letter written by a similar group of ob-gyn professors in 1972 predicted that freestanding clinics would be unnecessary if hospitals “cooperate in handling their proportionate share.”

This forecast never materialized. In the years following the 1973 Roe v. Wade Supreme Court ruling, federal court decisions and legislation — including the 1976 Hyde Amendment banning federal funding for abortions — marginalized the procedure in public hospitals and medical schools. Wary of the male-dominated health care industry, pro-choice activists opened their own low-cost clinics, which now perform 95% of abortions in the U.S.

“There are definitely instances of solidarity and courage where the medical community steps up and says that there are medical principles at stake,” says Donna Crane, policy director for NARAL Pro-Choice. “But by and large, this has been a fight waged by pro-choice communities.”

In the years since Roe v. Wade, political pressure and the promise of funding has been a powerful tool in preventing hospitals fromperforming abortions. The University of Arizona, for example, gave up its right to provide or teach abortions in 1974 in exchange for a $5.5 million football-stadium renovation. In Chicago, the Illinois Masonic Medical Center stopped performing abortions in 1991 in exchange for a deal to purchase land from the Chicago Catholic Archdiocese. Lawmakers in Arizona, Kansas and Texas have passed legislation barring state-funded institutions from providing abortion training to medical students, and seven other statesban abortion in public hospitals, according to the Guttmacher Institute.

“It’s generally not that hospitals don’t want to [perform abortions], but they feel tremendous pressure, either from laws that their legislators pass or from politics in general,” says Philip Darney, a professor of obstetrics and reproductive services at the University of California, San Francisco, and one of the lead authors behind the ob-gyn professors’ statement.

The marginalization of abortion within the medical community has made freestanding clinics an easy target for antiabortion activists, who picket, threaten and occasionally even kill abortion doctors. According to the Guttmacher Institute, an overwhelming majority (88%) of abortion clinics experienced some form of harassment — including protests, patient blocking, vandalism and bomb threats — in 2008, the most recent year for which data is available. In 2009, 67-year-old abortion provider George Tiller was shot and killed by an antiabortion activist while attending Sunday church services.

Many individual ob-gyns, including those who might want to provide abortions, are either unwilling or unable to provide the procedure. A 2010 survey of 30 ob-gyns found that of the 18 doctors who wished to provide abortions, only three were actually performing the service. The study also found that while some doctors expressed concern about violence, the majority were constrained by other professional factors, including hospital bans on the procedure, pressure from employers and other doctors in group practices, and a desire to get along with colleagues and nurses opposed to abortion.

In the end, many doctors are faced with the unsatisfying choice of either performing abortions, or becoming a practicing ob-gyn.

“I can train medical students and residents, but the question is, Where will they be allowed to practice this care?” says Nancy Stanwood, a professor at the Yale School of Medicine and board chair of Physicians for Reproductive Health. “And that comes down to the hospitals and other doctors in private practices, who might not be open to abortions.”

Despite these obstacles, however, pro-choice physicians say they have already made progress toward normalizing abortion in the medical community, most notably by expanding training through residency programs and family-planning fellowships. About 50% of the 200 ob-gyn residency programs in the U.S. now integrate abortion into training requirements, up from just 12% in 1992. Professors believe that a new generation of doctors will use their training to bring abortion back into hospitals and doctors’ offices. A 2011 study of ob-gyns found that female doctors and those ages 35 and younger were far more likely than their colleagues to perform abortions.

“It is very unusual for us to find new residents who don’t want to learn abortions,” Darney says. “They may find it difficult to practice, but we have a whole new generation of young women who are replacing the old men, and they have a very different view about their relationships with their patients. It’s very promising.”

Clarification: An earlier version of the doctors’ letter cited in the third paragraph of this piece was posted online March 18, 2013. On August 26, 2013, after the publication of TIME’s story, the American Journal of Obstetrics & Gynecology published the final version of the doctors’ letter online.

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I always find it funny that all the anti-abortion protesters near my house are middle aged/older white men. Are you that afraid of women being able to make choices and be on their own without needing a man?

Why isn't the "Choice" aspect ever credited to the very activity that leads to pregnancy? How is everyone who gets pregnant an unsuspecting victim?? Lastly, not taking responsiblity and instead "choosing" abortion is an immoral act of man (no religion necessary to tie to this issue) which the abortioner feels guilt from even if they were previously the "foaming at the mouth" abortionist type - I have seen this happen over and over again.

@oldskool I'm sorry do you want us to sit here and compare lists of anti-choice extremists who are also in jail or have been committed to mental institutions? Because that list has more than one name...

What is going to happen is what happened in the 20's. Back room operating rooms that are filthy and if there is a problem, both the woman & the baby will die. Of course, that is what the religious right wants, either follow their teachings or die!

There seems to be a growing willingness among anti-abortionists to agree that abortion should be provided in case of rape, incest, underage minor and medical emergencies. That women should not be forced to carry a rapist's child. it's a slow trend, and still a small group, but I suspect it will grow. A necessary evil if you are against abortions.

I also believe there is room for negotiation in setting the length of time before an abortion becomes late-term, and therefore, requiring more rigorous controls. Also, a necessary evil if you are for abortion rights.

The fact is, an abortion is the termination of life. Whether it's a human life dips into a moral, religious or speculative sophistry. But it is a termination of life, and it is a troubling thing for everybody, for or against. But it boils down to the health of the Mother, who even if not due to rape, incest or medical emergency would otherwise imperil herself with back-alley abortions if there is no other option, or try it herself. That's the reason Abortion needs to be provided in a controlled manner.

It is this situation that is the gordian knot. This is where both sides need to help each other find a middle ground. What is not acceptable is:

1) Religion using intimidation, violence and acts of terror, undue political pressure, bribes, threats of legal ruination to force the issue completely to their satisfaction

2) Laws requiring Counselors and Doctors to lie, or withhold medical information from the Mother. This is just outright wrong, and criminal.

3) Humiliating, exposing, torturing and in other ways threatening a Mother's safety. Though you may hate the Mother, do you really want the baby to be an orphan, if it somehow survives your ideology-fueled malice? Is bitter vehemence really like being Jesus?

I can see the sense of Medical professionals providing reasons not to get an abortion. If done carefully, with respect to the Mother already making a very difficult decision. And there has to be support for the Mother and Child if she carries it to term. You want to save the Fetus, be prepared to be responsible for the child. Is that what Jesus would do?

I mean really, People who say there should be no abortion and it's okay to kill Abortion Doctors in the name of God also believe their taxes should not be used for foodstamps? If a Kid is hungry and the Mother poor and struggling, that's their tough luck? Would Jesus say that?

This is a human issue. A very difficult one. Be Human, Humane and Wise in respect to its importance.

@whatsamatta_u No "middle ground" is needed. It's a longstanding ethical and safe procedure and will not be toyed with by the extremists. Please stop talking "compromise" as if this were some Middle East peace accord.

@whatsamatta_u I wasn't sure where you were going with that but you made some good points. I would also like to point out that many times when people are anti choice their whole ideology is based off the idea that the fetus or child or whatever you want to call it is innocent, but this fetus/child is innocent in instances of rape and incest as well so that is a really weak viewpoint on an important issue. Those people obviously haven't really thought about it, they view one fetus/child as more worthy than another.

Although abortion is not a good thing (granted) ... and nobody is really for it .. it is BETTER if Doctors do it than "back alley" medics because that is generally a double murder. There are underground medics (maybe some of them were army medics who knows) BUT they have primitive means, cause extreme damage to a woman (or girl), can cause fatal hemorrhage, are unable to provide sterile technique (hospitals have that), have no anesthetic, improper tools and infectious storage .. they may work in motels or even city parks .. it is a horrible consequence of criminalizing it ... PS the same medics are asked to treat gunshot wounds when robbers cannot go to a hospital and have he same deficient consequences.

oldskool: Being " old school " doesn't mean you have to be an ignorant fool. You can't seem to wrap your head around that there is absolutely nothing wrong or immoral with having an abortion. Nothing. Nothing is " killed "..it is something needed. Your message is the destructive one. Another thing who do you think gay people are? They are your kids..they are your brothers, sisters, cousins, aunts, uncles, neighbors, friends, co-workers, police officers, fire fighters,...brave men and women fighting in our armed forces. Being gay is normal and natural, a percentage of our population will ALWAYS BE BORN GAY. It is the way nature and God made them. Not the mention the even larger percentage of people are naturally bisexual. Educate yourself in biology and human sexuality. It is normal and natural in the animal kingdom in which we belong.....and by the way, being Liberal means your care about your fellow man, and care about doing what is right, moral, and just. Liberals are always fighting for good. THAT is what being a Liberal is all about. Educate yourself.

you think abortion is not killing- I think Kermitt Gosnells said something similar

no my sister, brother, uncles aunties and friends are not gay, neither are any of my neighbours, I'm not sure about the police and fire fighters although the few I know are not gay either

the only military person I know is gay is bradley AKA chelsea manning

My kids aren't gay either- I did not pass on the gay gene so they didn't get it from me plus i teach them that homosexuality is immoral

That born gay thing is intersting too

can i ask you

how did the gays pass on their gene? as last I noted they could not reproduce. I could be wrong but I would have thought that gene may well have become extinct millenia ago. Interesting that it would resurface in the past few decades as promiscuity and abortion makes its comeback also

You are ignorant and uneducated that is clear. Yes people are BORN gay. It is an innate, God given, natural, biological, unchangeable wonderful part of a person. ....and Yes you know someone who is gay or bisexual although you may not be aware of it. I don't think i mention a " gay gene " although there have been studies with a link. The same biological mechinism that made people heterosexual can also make them gay. It is hardwired in the brain.

I was born gay. I thank God for that. It's been a hard life but has taught me many important lessons in life and made me the spiritual man I am today.

And no in my belief system, abortion is not killing. There is nothing wrong or immoral about that. I'm wasting my breath because there is something wrong with you. You have a twisted view of the world.

@kapukane 1)If you are having sex with a man, your body doesn't like what you put it through. The muscles 'back there' are designed to push feces out, not take anything in. You also increase your (or your partner's) risk of getting anal lesions and cancer.(refer to the CDC for more info) The membranes in the anal region are not good at fighting disease either, and they cannot be easily protected against the germs and diseases that an obstructive object brings. Your body is simply not made to do what you want do with it. Your sperm has a purpose, and traveling up another man's cavity leads to....where? What is the purpose?

You are not 'loving' anybody by committing those acts with them. When somebody does this to you, they are not loving your body either.

2)There is everything immoral and wrong about ending innocent human life. Murder is never okay. Ever.

I suppose having an elementary understanding of how the reproductive system works, how the rear end muscles work, and when human life begins makes people bigoted. We're being taught now to simply ignore the science and just appeal to people's emotions and desires, regardless of what the facts show.

am I so transperent? how did you work me out so quickly, you read me like a book

Now let me read you-

you had an abortion- felt terrible about it, now you spend the rest of your life trying to convert others as it takes some of the pain from you knowing that you are supported by so many others, sounds familair?

Sorry Christy but you are very misguided. I was born gay, like all gay people. Many more people are naturally bisexual. That is normal human sexuality as in nature. Sex was designed by evolution for more than reproduction. And you are very mistaken. When two men make love it is one of the most beautiful things God has ever created. I thank God I was born gay and yes it is natural and normal. It is the way God and nature intended me to be. Many humans are not born heterosexual. You are misguided and unimformed. What kind of destructive message are you sending our young gay kids? They need our love, support, and above all to be told to be proud of who they are.